ADHD a Risk Factor for Addiction

Some say that people diagnosed with attention deficit hyperactivity disorder (ADHD) have a range of superpowers: energy, empathy, self-reliance, risk tolerance, resilience, and creativity — but as with any beneficial edge, there is a cost. For many with ADHD, the flip side can include a heightened risk of impulsivity, anxiety, depression, and notably, addiction. While the perceived superpowers might be validated by the perceptions of individuals, the risk factors are seen fairly consistently at the population level.
The correlation to addiction starts early. A recent Trinity College study shows that attention problems in adolescence can predict substance use in young adulthood. This longitudinal study of 1,000 participants spanned from ages 14 to 23. As the researchers summarized in the study’s abstract:
Behaviors and brain connectivity associated with diminished sustained attention at age 14 predicted subsequent increases in cannabis and cigarette smoking, establishing sustained attention as a robust biomarker for vulnerability to substance use. (Emphasis added.)
Complicating matters, researchers add: “[I]t remains unclear if impaired sustained attention predates the initiation of substance use and/or if it is a consequence of substance use.”
Sustained attention is readily understood as necessary to thrive in contemporary society. Those who struggle to do so face difficulties learning and meeting social expectations early in life, and academic and/or social achievement later. These pressures frequently yield mental health issues in those with ADHD.
Wait, What? Who?
ADHD is a neurodevelopmental difference — officially a “disorder” but we’ll describe it here as one form of neurodivergence. The wording is important. As ADHD was diagnosed in the 1990s (then called ADD) social scientist Judy Singer observed how the language around neurodivergent people focused on deficits and pathology. By changing how we refer to people with different ways of experiencing the world, including ADHD, we validate their humanity and inherent worth.
The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) makes several updates based on ongoing research into neurodivergence. With regard to ADHD, there remain two agreed-upon presentation specifiers across 18 primary symptoms: inattention and hyperactivity/impulsivity.
As the BBC explains:
People with inattention may forget things, struggle to get organised, and find themselves easily distracted. Those with hyperactivity and impulsivity might struggle to stay sitting down, constantly fidget, and interrupt conversations.
The cliché image of someone with ADHD is an unruly young boy bouncing off the walls in school; indeed, depending on the study, boys are diagnosed at ratios between 2:1 to 10:1 to girls. Research suggests this wide diagnosis gap has both biological and social (gender bias) origins.
This diagnosis gap matters. Girls and women who are not diagnosed, or diagnosed later in life, are at increased risk of several self-destructive behaviors as compared to their non-ADHD peers.
As UCLA Health writes:
Years — even decades — of living with untreated ADHD can also take a toll on women’s self-esteem and mental health. They may feel like failures or blame themselves for being too lazy or too disorganized to cope with all that adult life demands of them.
That self-blame can sometimes lead to self-destructive behaviors and other challenges. Women with ADHD are more likely to also suffer from: cutting or other methods of self-harm, eating disorders, insomnia, mood disorders, such as anxiety or depression, and substance use (drugs or alcohol).
Let’s pause to look at that list. One condition, ADHD, correlates with multiple destructive behavioral responses in women and girls. Readers of AddictionNews, familiar with A Unified Theory of Addiction, will recognize all of these as components of addiction.
ADHD Increases Many Lifetime Risks, Including Addiction
Regardless of gender, children and adults with ADHD experience increased lifetime risks of negative outcomes, including addiction. These include mental health (e.g. depression), physical health (e.g. obesity), and societal outcomes (e.g. imprisonment, divorce) compared to peers, according to a meta-analysis.
As the researchers write:
Newer areas of research which included fewer reviews showed evidence of associations between ADHD and internet, gaming and gambling addictions, suggesting a relationship between ADHD and addiction which transcends a range of types of addiction. Further research is needed to disentangle the links between ADHD and addiction.
What can we take away from these studies? First, that ADHD imparts lifelong increased risk factors that influence destructive and/or addictive behaviors. Second, that ADHD is underdiagnosed in girls and women. This gap puts even more pressure and stress on girls and women, further increasing the potential for negative coping mechanisms and mental health harm. Third, we’re just beginning to fully appreciate the range of harms and — yes — benefits of ADHD.
This way of sensing and interacting with the world shouldn’t be stigmatized. It should be acknowledged as one area where early diagnosis, treatment, and coping techniques can reduce the potential for later addiction, especially in girls.
Written by Katie McCaskey. First published October 16, 2024.
Sources:
“10 Surprising Benefits of Having ADHD,” Very Well Health, December 11, 2023.
“What I Would Never Trade Away,” ADDitude, July 22, 2022.
“A robust brain network for sustained attention from adolescence to adulthood that predicts later substance use,” eLife Sciences, September 5, 2024.
“Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR),” American Psychiatric Association, undated.
“Neurodiversity: A Brief History,” California Institute of Technology, undated.
“DSM-5 Changes: Attention Deficit Hyperactivity Disorder,” Psych Central, May 20, 2013.
“Why is ADHD Missed in Girls?,” BBC, June 3, 2019.
“Using an epidemiological approach to investigate sex differences in the manifestation of ADHD in youth and adulthood,” Kings College London, 2018.
“Sex differences in ADHD symptom severity,” PubMed, June 2015.
“ADHD in girls and boys — gender differences in co-existing symptoms and executive function measures,” BMC Psychiatry, November 9, 2013.
“How to recognize ADHD in women,” UCLA Health, April 26, 2024.
“A Unified Theory of Addiction,” Dr. Pretlow, March 9, 2023.
“The impacts associated with having ADHD: an umbrella review, Frontiers, May 20, 2024.
Image Copyright: Ramil Gibadullin.